[ChatGPT and the German board examination for ophthalmology: an evaluation]. / ChatGPT und die deutsche Facharztprüfung für Augenheilkunde: eine Evaluierung.

PURPOSE: In recent years artificial intelligence (AI), as a new segment of computer science, has also become increasingly more important in medicine. The aim of this project was to investigate whether the current version of ChatGPT (ChatGPT 4.0) is able to answer open questions that could be asked in the context of a German board examination in ophthalmology. METHODS: After excluding image-based questions, 10 questions from 15 different chapters/topics were selected from the textbook 1000 questions in ophthalmology (1000 Fragen Augenheilkunde 2nd edition, 2014). ChatGPT was instructed by means of a so-called prompt to assume the role of a board certified ophthalmologist and to concentrate on the essentials when answering. A human expert with considerable expertise in the respective topic, evaluated the answers regarding their correctness, relevance and internal coherence. Additionally, the overall performance was rated by school grades and assessed whether the answers would have been sufficient to pass the ophthalmology board examination. RESULTS: The ChatGPT would have passed the board examination in 12 out of 15 topics. The overall performance, however, was limited with only 53.3% completely correct answers. While the correctness of the results in the different topics was highly variable (uveitis and lens/cataract 100%; optics and refraction 20%), the answers always had a high thematic fit (70%) and internal coherence (71%). CONCLUSION: The fact that ChatGPT 4.0 would have passed the specialist examination in 12 out of 15 topics is remarkable considering the fact that this AI was not specifically trained for medical questions; however, there is a considerable performance variability between the topics, with some serious shortcomings that currently rule out its safe use in clinical practice.

The Peters'-Plus syndrome: description of 16 patients and review of the literature.

Peters'-Plus syndrome is characterized by Peters' anomaly, a typical face, cleft lip and palate, short limb dwarfism, and developmental retardation. We report the follow-up of six patients in the original report, 10 yet unreported patients, and review 26 patients that have been reported in the literature. The spectrum of the syndrome is broadened by data from affected sibs which indicate that a wider range of anterior chamber cleavage disorders may be present, a cleft lip or palate need not be present, and developmental retardation may be mild or even absent. An increased foetal loss in families with Peters'-Plus syndrome may indicate intrauterine death of some foetuses affected by the syndrome. The pattern of inheritance is autosomal recessive.

Report of general temporary anticoagulation in the treatment of acute cerebral and retinal ischaemia.

BACKGROUND: Recurrent thrombo-embolism represents by far the commonest cause of cerebral and retinal ischaemia. In an open clinical study, experience with a largely general anticoagulation in the acute phase of cerebral and retinal ischaemia is reported. METHODS: From October 1993 to October 1996, 781 patients with acute cerebral ischaemia were admitted to the medical emergency ward. Taking contra-indications into consideration and after CT exclusion of cerebral haemorrhage (2%). Immediate therapeutic heparinisation (1.5-2-fold prolongation of aPTT) was administered to 664 patients (85%) over 7-10 days. In a concurrent Doppler/duplex comparative study, 143 patients with retinal artery occlusion were investigated for the prevalence of potential sources of emboli in the region of the extracranial carotids and internal carotid circulation respectively. 108 patients served as a reference group whose acute loss of vision of vascular origin could be attributed to retinal vein thrombosis. RESULTS: The complication rate of anticoagulation in acute cerebral ischaemia was 0.8% (major complications), and the recurrence rate during the period of treatment was 2.4%. In 131 patients with acute retinal ischaemia, therapeutic heparinisation was performed without ocular cerebral or extracerebral complications. Potential ipsilateral sources of emboli (highgrade carotid stenosis or complex plaques with thrombotic deposits) were found in 55%, but in only 7% of the control group (p < 0.0001). CONCLUSION: Immediate anticoagulation in the form of aPTT-monitored therapeutic heparinisation represents a rational and low-risk concept for the treatment of acute cerebral and retinal ischaemia.

[Medical malpractice in ophthalmology]. / Behandlungsfehler in der Augenheilkunde.

BACKGROUND: The increasing number of patients taking action for medical malpractice (MM) is a burden for the medical practitioners accused. After the assessment through an arbitration committee, which is free of cost for the patients,a large number of lawsuits can be avoided. Discussion of patient complaints and analyzing cases of MM is an important concern for the medical community in order to reduce errors in treatment and to contribute to patient safety. MATERIAL AND METHODS: The patient applications to the arbitration committee of the medical association of North-Rhine ("Gutachterkommission Nordrhein") for review of MM in the field of ophthalmology in the years 1999-2010 were analyzed statistically. RESULTS: In the years 1999-2010 a total of 583 cases were related to ophthalmology (3% of all cases) and in 122 cases (21%) MM was recognized by the committee. In 61% of the cases MM was caused by errors in diagnosis, in 24% by errors in processes and in 15% by errors in surgical procedures. CONCLUSIONS: The proportion of ophthalmological cases in the total number of MM cases is low. Most errors in diagnosis are caused by the lack of basic diagnostic on examination procedures. Errors in processes are caused by instrumental errors and deficient communication. An important reason for errors in surgical procedures is a deficient management of complications. A standardized workflow of medical examinations and a quality management can help to avoid MM.

[Viscosurgically assisted hydro-jet irrigation of the lens nucleus. An effective procedure for extracapsular cataract extraction with capsulorhesis]. / Viskochirurgisch unterstützte Hydro-Jet-Ausspülung des Linsenkerns. Ein sicheres Verfahren zur extrakapsulären Kataraktextraktion mit Kapsulorhexis.

BACKGROUND: To reduce costs and to be independent of high technology equipment it is desirable to perform cataract operations of high quality manually. MATERIALS AND METHODS: The manual operation includes a spiral shaped capsulorhexis, hydrodissection of the nucleous and its consequent delamination by means of hydroxypropylmethylcellulose (Metho). A bent cannula is used to create a jet stream of fluid separating the nucleous from the cortex and pressing the nucleous out of the bag. The cannula is connected to an infusion system 80 cm above the patient's eye. The nucleous slips into the anterior chamber and is delivered by injection of Metho, the injection cannula acts as a spatula to facilitate nucleous delivery. The nucleous also can be fragmentated for reduced incision length. The method was combined with an 8 mm tunnel incision. The implanted lenses had 7 mm optics and 10 or 11 mm haptics. In 100 consecutive operations (48 in males and 52 in females respectively) daily clinical examination was carried out for 7 days including the day of operation. Complications occurring during this time were listed. RESULTS: No lesion of the capsule/zonule diaphragm occurred. In 3 cases corneal edema was observed, which disappeared within 5 days totally. In 2 cases a continuous rhexis was not achieved, but the lens was situated in the bag and centered well in these cases as well as in the 98 eyes with intact capsulorhexis. CONCLUSIONS: The method described is safe. Using a purely manual operation technique it is possible to achieve an excellent lens fixation in the bag with undamaged rehexis rim and scleral tunnel incision.

[Stereoscopic vision with central scotomata (author's transl)]. / Stereosehen bei zentralen Skotomen.

Thirty-nine patients with convergent microstrabismus and 24 patients with central organic scotoma underwent measurements of stereo acuity. Stereopsis at distance was measured by means of a polarization haploscope using "plane-tests" and random dot tests respectively. For near stereopsis were used commercially available tests (Titmus Test, TNO-Test). Organic scotomata can be divided into "circumscribed central scotomata" and "sievelike scotomata", the latter leading to poorer performance in random dot tests. Large plane tests yielded better results than small ones. In microstrabism we found stereo acuities similar to those of patients with "sievelike scotoma". The results support the theory of displacement of fusion within Panum's area in microstrabismus leading to decreased local stereopsis due to decreased concentration of stereo units at the border of Panum's area.

[Decreasing local stereopsis with increasing horizontal disparity, indicating decreasing density of binocular cortical projection towards the limits of Panum's area (author's transl)]. / Abnehmende lokale Stereopsis mit zunehmender Querdisparation, ein Hinweis auf abnehmende Dichte der binokularen Projektion am Rande des Panumareals.

Measuring local stereopsis by means of random dot stereograms with increasing horizontal disparity, the relative density of binocular cortical projection has been determined at a distance of 75 min of arc from the fovea. The accuracy of stereoscopic perception decreased with increasing horizontal disparity. The reciprocal value of the error frequency was used to measure the density of binocular cortical projection. Panum's area at the above mentioned distance from the fovea can be constructed by plotting the error frequency against the horizontal disparity. We observed a decrease of the relative density of binocular cortical projection towards the limits of Panum's area without a sharp break. The results are in agreement with those reported by Bishop and Henry and Joshua in the cat (receptive field disparity). The theory of stereopsis as proposed by Bishop explains our findings well and may be transferred to binocular vision in man.

[Visco-hydraulic irrigation of the lens cortex. A safe ECCE method]. / Visko-hydraulische Rindenausspülung. Ein sicheres ECCE-Verfahren.

BACKGROUND: The safe and effective Hydrojet nucleus expression (Klin Monatsbl Augenheilkd 1993; 202:288-291) should be completed by a safe non traumatic and easy to perform method of cortex removal. MATERIAL AND METHODS: OPERATION TECHNIQUE: 8-mm tunnel incision, spiral capsulorhexis, hydrodissection and viscodissection of the nucleus, hydrojet nucleus expression. The lens cortex can be separated from the lens capsule by injection of hydroxypropylmethylcellulose (Metho), the viscoelastic substance acts as a wedge to separate the cortex from the capsule step by step. Finally the cortex is expressed by the injection of Metho. The capsule remains so clean, that often polishing is not necessary. PMMA lenses with an over all diameter of 10 or 11-mm and 7-mm optics were implanted. In 100 consecutive cases complications which occurred intraoperatively or within the following 2 days were listed. RESULTS: The following complications occurred: Hyphaema (2x, the blood disappeared spontaneously within 4-5 days), small cortex flake in the anterior chamber (2x), rhexis rim not intact (1x, nevertheless exact lens centration in the bag). No lesion of the capsule/zonule diaphragm, no fibrin reaction, no corneal edema. CONCLUSION: The method described is a safe method for ECCE. Capsulorhexis and tunnel incision are required. The method does not need any high technology equipment.

[Objective determination of refraction]. / Objektive Refraktionsbestimmung.

Objective determination of refraction is basically necessary for the subjective adjustment of refraction aimed at prescribing glasses. At least as important is the use of objective determination of refraction as a basis of ophthalmological diagnosis because the best-corrected visual acuity forms basic diagnostic information. Three methods of objective determination of refraction are available. Photorefraction has only been used for screening preschool children, as it has no value for the above-mentioned purpose. Refractometry is widely being used for objective determination of refraction, and during the last few years automated refractometry has also become more and more common. This trend is supported by the possibility of delegating automated refractometry to assistant medical personnel. Retinoscopy and automated refractometry yield comparable results. Retinoscopy has some advantages: great flexibility and the fact that retinoscopy forms an image of optical aberrations of the eye, giving the ophthalmologist an idea of the optical quality of the patient's eye. Due to its flexibility retinoscopy can be used for refractioning babies and infants without any problem. The disadvantage of retinoscopy is the impossibility of delegating it to assistant medical personnel and the fact that this method must be learned by the ophthalmologist. In contrast to retinoscopy, automated refractometry can easily be learned and can be delegated to assistant medical personnel. Its drawback is that it is inflexible, making it inconvenient for refractioning babies and infants. If automated refractometry and retinoscopy are used with cycloplegia, precautions are essential to avoid errors caused by optical aberrations of the eye. The measurement must be done in the center of the pupil.(ABSTRACT TRUNCATED AT 250 WORDS)

[Refraction in the 1st year of life and the development of astigmatism]. / Die Refraktion im 1. Lebensjahr und die Entwicklung des Astigmatismus.

Retinoscopy was performed in 205 children under atropine cycloplegia during the first year of life. In 22% an astigmatism (minimum 1.0 D) was found with a small peak of incidence between the 31st and 40th week. In a follow-up study (45 children) the incidence and degree of astigmatism were found to increase slightly. During the first 3 years of life esotropic children developed an astigmatic anisometropia (minimum 1.0 D difference in the astigmatism of the two eyes) more frequently the non-esotropic children. The hypothesis that astigmatic anisometropia is produced by visual deprivation in esotropic individuals is discussed.

[Abnormalities in the vessels of the iris as seen in fluorescein angiography (author's transl)]. / Gefässanomalien der Iris im Fluoreszenzangiogramm.

There are unusually thick serpentine vessels in the iris along which there are no leaks in the fluorescein angiogram. Five and a half to seven years ago this was considered to be a sign of normal iris vessels in our department. It was assumed that this was only an abnormality. In four instances we have been able to find this irregularity, without any changes, in the vessels in the iris where it was a question of shunt vessels. In three of these four instances other diseases of the eyes were also present.

Fluorescein angiography of the corneal limbus--drug effects on capillary blood flow.

By means of fluorescein angiography, plasma flow through the capillaries at the limbus corneae is demonstrated. The number of stained capillaries at a given time served as a measure of capillary perfusion. Even without drug the entire capillary system is perfused at least by plasma. Tolazoline enhanced the velocity of perfusion (P = 2alpha less than 0.01), epinephrine caused a marked capillary constriction (P = 2alpha less than 0.01), as well as--to a lesser extent--did dexamethasone (P = 2alpha less than 0.05). Dionine caused hyperemia, but the data varied much more than after tolazoline. In addition, dionine enhanced the dye leakage from the vessels.